CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 4 2.500000 92.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 131 203.500000 7529.5000 37.0000
Subtotal (Total Children Is Unduplicated) 131 206.000000 7622.0000 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 62 63.000000 3176.1500 50.4151
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 59 59.000000 2996.9500 50.7958
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 33 33.000000 1684.6500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 148 164.000000 8317.2000 50.7146
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 69.750000 3487.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 64 5379.000000 134475.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1100 10502.00000 525100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1120 11007.00000 110070.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 105 599.000000 42638.8400 71.1834
OCCT-97530HM-OT SESSION BY OT ASST 34 173.500000 9924.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 77 369.000000 26102.9700 70.7398
PHY-97110HM-PT SESSION BY PT ASST 87 625.500000 35753.5800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 74 351.750000 25093.3000 71.3385
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 8.000000 457.6000 57.2000
Subtotal (Total Children Is Unduplicated) 1308 29097.50000 913752.9900 31.4031
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Total 29467.500000 929692.1900 31.5497
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Number of Children (Unduplicated) With at Least One Service 1361
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Center 04
Flag Claims Units Chgs Paid
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R 17 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 30 30.250000 1119.2500 0.0000
P 3591 13636.000000 248050.0600 248050.0600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2302 9508.500000 486860.6400 350.0000
T 0 0.000000 0.0000 0.0000
529 6040.250000 177507.8700 0.0000
Other 95 237.500000 15599.3700 322.9000
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Total 6564 29467.500000 929692.1900 248722.9600